Provider Demographics
NPI:1184048043
Name:LAKEY, KATHLEEN FITZWILLIAM (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FITZWILLIAM
Last Name:LAKEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:FITZWILLIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:275 E SOUTH TEMPLE
Mailing Address - Street 2:STE 101
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1247
Mailing Address - Country:US
Mailing Address - Phone:385-218-8266
Mailing Address - Fax:801-364-1433
Practice Address - Street 1:275 E SOUTH TEMPLE
Practice Address - Street 2:STE 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1247
Practice Address - Country:US
Practice Address - Phone:385-218-8266
Practice Address - Fax:801-364-1433
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7698951-35011041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical